Authors:

Background: Patients with chronic conditions routinely see multiple outpatient providers, who may or may not communicate with each other. Gaps in information across providers caring for the same patient can lead to harm for patients. However, the exact causes and consequences of healthcare fragmentation are not understood well enough to design interventions to address them. Read More

Background: As the number of people with chronic diseases increases, understanding the impact of payment model on the types of patients seen by specialists has implications for improving the quality and value of care. We sought to determine if there is an association between specialist physician payment model and the types of patients seen.

Methods: In this descriptive study, we used administrative data to compare demographic characteristics, illness severity and visit indication of patients with diabetes seen by fee-for-service and salary-based internal medicine and diabetes specialists in Calgary and Edmonton between April 2011 and September 2014. Read More

Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Objective: To elicit perspectives of family physicians and patients with knee osteoarthritis (KOA) on KOA, its treatment/management and the use of a mobile health application (app) to help patients self-manage their KOA.

Design: A qualitative study using Cognitive Task Analysis for physician interviews and peer-to-peer semistructured interviews for patients according to the Patient and Community Engagement Research (PaCER) method.

Setting: Primary care practices and patient researchers at an academic centre in Southern Alberta. Read More

Scientific Affairs,Canadian Agency for Drugs and Technologies in Health,Ottawa, Ontario,Canada.

Objectives: To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI.

Authors:

Interview by Rona Williamson Steve Bloom was born in Kent in 1942 and received his undergraduate medical training at Cambridge University, Cambridge, UK. His House Officer, Senior House Officer and Registrar posts were undertaken at The Middlesex Hospital where he also received an MRC Clinical Research training Fellowship. He moved to the Royal Postgraduate Medical School at Hammersmith Hospital as a Consultant Physician in 1974 where in due course he became Professor of Medicine. Read More

The retraction of >30 falsified studies by Anversa et al. has had a disheartening impact on the cardiac cell therapeutics field. The premise of heart muscle regeneration by the transdifferentiation of bone marrow cells or putative adult resident cardiac progenitors has been largely disproven. Read More

SPONASTRIME dysplasia is an autosomal-recessive spondyloepimetaphyseal dysplasia characterized by spine (spondylar) abnormalities, midface hypoplasia with a depressed nasal bridge, metaphyseal striations, and disproportionate short stature. Scoliosis, coxa vara, childhood cataracts, short dental roots, and hypogammaglobulinemia have also been reported in this disorder. Although an autosomal-recessive inheritance pattern has been hypothesized, pathogenic variants in a specific gene have not been discovered in individuals with SPONASTRIME dysplasia. Read More

Authors:

Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

Background: We previously demonstrated that unidentified aliased patients, John Doe's (DOEs), are one of the highest risk and most medically fragile populations of injured patients. Aliasing can result in misplaced information and confusion that must be overcome by health care professionals. DOE alias use is institutionally dependent and not uniform, which may lead to significant variation in perception of confusion and error. Read More

Background: This monocentric study aimed to explore whether key non-technical attributes can be reliably measured in a mixed population of candidates applying for surgical training, surgical trainees and staff and to identify any differences between these groups.

Background And Aims: Heavy alcohol use is a risk factor for disease and mortality; however epidemiological findings have demonstrated protective effects of a light-to-moderate intake of alcohol on cardiovascular health. There are many misconceptions regarding appropriate levels of alcohol intake and the risks and benefits of consumption. We sought to examine physician attitudes and recommendations regarding alcohol intake in a cohort of Uruguayan cardiologists. Read More

Authors:

A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. M. Daniel is assistant dean of curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. S.A. Santen is senior associate dean of evaluation, assessment, and scholarship of learning, and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. A. Swan-Sein is director, Center for Educational Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean of curriculum and associate professor of cell biology, NYU School of Medicine, New York, New York.

An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and populations. These curricular reforms often include a shortened pre-clerkship phase with earlier introduction of learners into clinical environments. This has led schools to reconsider the optimal timing of United States Medical Licensing Examination Step 1 exam. Read More

Objectives Young athletes do not always seek medical help for overuse wrist injuries, risking invalidating long-term consequences resulting from late diagnosis. This study aimed to develop a questionnaire to identify overuse wrist injuries in young athletes. Methods According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria, items were collected from literature and 6 focus groups of sports physicians and of young athletes with (previous) overuse wrist injuries. Read More

Background: Regorafenib is considered a standard of care as third-line therapy in metastatic colorectal cancers (mCRCs).

Materials And Methods: The study was based on a computerized clinical data form sent to oncologists across the country for entry of anonymized patient data. The data entry form was conceived and generated by the coordinating center's (Tata Memorial Hospital) gastrointestinal medical oncologists and disseminated through personal contacts at academic conferences as well as through E-mail to various oncologists across India. Read More

Authors:

, , , , and are Academic Nephrology Attending Physicians at the James A. Haley Veterans' Hospital and Assistant Professors at the University of South Florida Department of Nephrology and Hypertension, all in Tampa, Florida. At the time the article was written was a Medical Fellow at the University of South Florida.

Imaging at the nephrology point of care provides an important and continuously expanding tool to improve diagnostic accuracy in concert with history and physical examination. Read More

Objectives: To evaluate the effect of monetary grants on young physicians' choice of remote or rural hospital-based practice.

Background: In late 2011, The Israeli Ministry of Health attempted to address a severe physician maldistribution, which involved severe shortages in remotely-located institutions (RLI). The policy intervention included offering monetary grants to residents who chose a residency program in a RLI. Read More

Authors:

Emergency Medicine, University of South Carolina College of Medicine, Greenville, USA.

The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series was created in 2014 to address a lack of both curation of online educational content and a nationally available curriculum that meets individualized interactive instruction. Using an expert-based, crowdsourced approach, the AIR series identifies trustworthy, high-quality, educational blog and podcast content. Here, we summarize the content rated as high quality per our a priori criteria as evaluated by eight attending physicians. Read More

Authors:

Background: Physician engagement has become a key metric for healthcare leadership and is associated with better healthcare outcomes. However, engagement tends to be low and difficult to measure and improve. This study sought to efficiently characterize the professional cultural dynamics between physicians and administrators at an academic hospital and how those dynamics affect physician engagement. Read More

Authors:

Chronic venous disease (CVD) is a prevalent condition that tends to worsen with age. Patients initially seek treatment to relieve symptoms of leg pain, discomfort, heaviness and swelling, all of which impact their quality of life. As the disease increases in severity to include varicose veins, skin changes, and venous ulcer, the demand for treatment increases while the quality of life further diminishes. Read More

Background: Providing financial incentives has gained popularity as a strategy to promote weight loss, but questions remain about how best to utilize them. A promising mobile health strategy provides users with near-real-time financial incentives based on both the process of weight loss (behavioral modification) and actual weight loss. To maximize the impact of this strategy, a methodology is needed to close the gap between the desired behavior and the financial incentive. Read More

Authors:

2 Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, New York, NY, USA.

Objectives:: Standards of care for total laryngectomy (TL) patients in the postoperative period have not been established. Perioperative care remains highly variable and perhaps primarily anecdotally based. The aim of this study was to survey members of the American Head and Neck Society to capture management practices in the perioperative care of TL patients. Read More

Authors:

2 Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA.

Objective: To explore an interprofessional group of health care providers' perspectives on the facilitators and barriers to implementation of an inpatient acupuncture service for pain and symptom management.

Authors:

The shift to competency-based medical education (CBME) requires a new approach to program evaluation. CBME implementers need to embed evaluation in their programs to ensure their CBME adapts to the changing demands of the healthcare system. This 12 tips paper proposes that those advancing CBME use an improvement-oriented, utilization-focused approach to program evaluation. Read More

Background: Clinician-scientists (CSs) are physicians who work in daily care and have an academic role in research or education. They may act as knowledge brokers and help to connect research and clinical practice. There is no data available on CSs' brokering activities and the perceived barriers and facilitators to optimising their role in general practice (GP) and elderly care medicine (EM). Read More

Authors:

University Central Florida, College of Medicine, Altamonte Springs, Florida.

Despite the steady increase in female medical students and female faculty in the US, there has been little change in the distribution of women across the ranks of assistant, associate, and full professor over the past 30 years. Women are substantially less likely than men to be full professors even after accounting for age, experience, specialty, and measures of research and clinical productivity. From 2009 to 2017, the percentage of female faculty in emergency medicine dropped from 3% to 1. Read More

Background: PYRAMID was an international multicenter, noninterventional, postmarketing registry assessing long-term safety and effectiveness of adalimumab (Humira), as used in routine clinical practice.

Methods: Adult patients with moderately to severely active Crohn's disease with or without prior adalimumab experience were enrolled in the registry and followed for up to 6 years. Effectiveness measurements included the Physician's Global Assessment (PGA, a composite of Harvey Bradshaw Index [HBI] and rectal bleeding score), clinical remission (HBI < 5), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and Work Productivity and Activity Impairment (WPAI) questionnaire. Read More

Authors:

Background: Rapid changes in health care are driving the adjustment of work flow by which providers serve patients in team-based care. Specifically, there is a need to develop more effective and efficient utilization with accurate attribution of advanced practice providers' (APPs) productivity.

Local Problem: The Directors of the APP-Best Practice Center conducted assessments of each clinical area at MUSC Health, a large academic medical center. Read More

Authors:

Division of Digestive and Liver Disease, Department of Medicine, Columbia University, New York, New York, USA.

Endoscopy training remains an apprenticeship, and the characteristics that facilitate transfer of high quality procedural skills from role models to trainees are unknown. We sought to determine whether unobserved supervisor performance influences the quality of colonoscopy performed by trainees, by studying how supervisors perform alone and how trainees perform while under those same supervisors. This was a retrospective cross-sectional study conducted among ambulatory adults ≥ 50 years old who underwent colonoscopy for cancer screening or polyp surveillance from 2006 to 2015 at one academic medical center. Read More

Authors:

Department of Urology, University of California, San Francisco, San Francisco, California.

Introduction: Rising health care costs are leading to efforts to minimize costs while maintaining high quality care. Practice variation in the operating room that is not dictated by patient necessity or clinical guidelines presents an opportunity for cost containment. We identified variation in surgical supply costs among urological surgeons performing laparoscopic nephrectomy and evaluated whether this variation was associated with patient outcomes. Read More

Rationale And Objectives: Diagnostic radiology training programs are less diverse than graduating US medical school classes and the patient populations they serve. Inclusion of physicians who are underrepresented minorities in medicine (URMM) can strengthen the profession and help to meet the needs of an increasingly diverse population. Our Department of Radiology developed and implemented a plan to increase the number of URMMs in our residency applicant pool and residency training program. Read More

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. Read More

Authors:

Division of Rheumatology, UCSF and the Veterans Affairs Medical Center - San Francisco, San Francisco, CA.

Objective: Applying treat to target strategies in the care of patients with rheumatoid arthritis (RA) is critical for improving outcomes, yet electronic health records (EHRs) have few features to facilitate this strategy. We evaluated the effect of three health-IT initiatives on performance of RA disease activity measures and outcomes in an academic rheumatology clinic.

Methods: We implemented three initiatives designed to facilitate performance of the Clinical Disease Activity Index (CDAI): an EHR flowsheet to input scores, peer performance reports, and an EHR SmartForm including a CDAI calculator. Read More

Authors:

Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.

Inborn errors of metabolism (IEMs) are rare genetic or inherited disorders resulting from an enzyme defect in biochemical and metabolic pathways affecting proteins, fats, carbohydrates metabolism or impaired organelle function presenting as complicated medical conditions involving several human organ systems. They involve great complexity of the underlying pathophysiology, biochemical workup, and molecular analysis, and have complicated therapeutic options for management. Age of presentation can vary from infancy to adolescence with the more severe forms appearing in early childhood accompanied by significant morbidity and mortality. Read More

Authors:

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. Read More

Objective: The detection of distant metastatic disease in cervical cancer patients at diagnosis is critical in accurate prognostication and directing treatment strategies. This study describes the frequency and sites of distant metastatic disease at diagnosis in patients with cervical cancer as detected by positron emission tomography with F-fluorodeoxyglucose (FDG-PET).

Achieving health equity requires an evaluation of social, economic, environmental, and other factors that impede optimal health for all. Family medicine has long valued an ecological perspective of health, partnering with families and communities. However, both the quantity and degree of continued health disparities requires that family medicine intentionally work toward improvement in health equity. Read More

Authors:

Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment mono-neuropathy of the median nerve. In comparison to open surgical and endoscopic carpal tunnel release, a new ultrasound guided hook knife carpal tunnel release (CTR) procedure was reported to have superior results in terms of reduced morbidity and early return to work.

Objective: To evaluate the reproducibility of the hook knife CTR procedure when performed by musculoskeletal ultrasound trained physicians without a prior experience in this technique. Read More

Authors:

Western Sydney University, School of Medicine, Campbelltown, New South Wales, Australia.

Background: Motivation to become a doctor has typically been conceived as arising from personal interests. However, it is not uncommon, particularly amongst those from collectivist cultures, for career choice to be motivated by a desire or need to fulfil parent expectations. Whether or not this motivation has longer term effects on the career satisfaction and performance of medical students is unknown. Read More

Authors:

University of California, San Francisco, California, United States of America.

Background: Open Payments is a United States federal program mandating reporting of medical industry payments to physicians, increasing transparency of physician conflicts of interest (COI). Study objectives were to assess industry payments to physician-editors, and to compare their financial COI rate to all physicians within the specialty.

Methods And Findings: We performed a retrospective analysis of prospectively collected data, reviewing Open Payments from August 1, 2013 to December 31, 2016. Read More

Authors:

L.A. Dossett is assistant professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan. M.W. Mulholland is chair and professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan. E.A. Newman is assistant professor and associate chair for faculty development, Department of Surgery, University of Michigan, Ann Arbor, Michigan.

Problem: In academic surgery, women and physicians from ethnic minority groups remain inadequately represented relative to their representation in the US population and among medical students and surgical trainees. While several initiatives have been aimed at developing the academic surgery pipeline or addressing issues related to faculty retention and promotion, little is known about how recruitment practices impact diversity in academic medicine. Moreover, national standards and ideal practices specific for effective recruitment in surgery have not been established. Read More

Authors:

In this issue of Academic Medicine, Lundsgaard and colleagues present "Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence," a qualitative exploration of how various stakeholders contribute to the understanding of trainee competence. Drawing on stakeholder theory from business management, the authors of that report explore how the perceptions of key stakeholders (leaders/administrators, nurses/nurse practitioners, trainees, and patients) either confirm, enhance, or complicate the picture of competence that emerges from the perspectives of senior physician supervisors.In this Invited Commentary, the author considers the potential effects of applying stakeholder theory to educational assessment and elaborates on Lundsgaard and colleagues' findings that additional stakeholder perceptions may be redundant in some instances and present conflicting understandings of competence in others. Read More

Authors:

Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric. Read More

Authors:

Background: Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis. Read More

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents.

Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Read More

Introduction: Uterine leiomyosarcomas (ULMS) account for 1% of all uterine malignancies and for 30% of all uterine sarcomas. The preoperative diagnosis of ULMS is challenging for the physicians, as the symptoms of these tumors are often vague and nonspecific. Moreover, as ULMS have an aggressive biologic behavior, affected women frequently have very poor prognosis. Read More

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